Effect of antihypertensive treatment at different blood pressure levels in patients with diabetes mellitus: systematic review and meta-analyses

According to the new guidelines for treatment of hypertension, it is recommended to initiate pharmacological treatment in diabetic patients when their blood pressure goes above 140/90. This recommendation is one of many that come from JNC 8, a trusted guideline by pharmacists and doctors all over the world. One issue with the JNC treatment guidelines, however, is that while they give extensive and thorough recommendations about the initiation of antihypertensive therapy, they offer little to no recommendations about when antihypertensives should be continued or stopped after a goal blood pressure has been reached.

 

In this review article that looked at 49 randomized controlled trials, it was determined that further treatment of diabetes patients with anti-hypertensives after they were below goal blood pressure actually increased risk of cardiovascular death as well as correlated to an increase towards all types of mortality. This surprised me because it seems counterintuitive that antihypertensive medications could ever increase the possibility of a cardiovascular death, even in a patient with healthy blood pressure.

 

I think this article may shed some light on the “if it ain’t broke don’t fix it” attitude of many doctors towards maintenance medications. Many doctors will keep their patients on anti-hypertensives or statins even if the patient’s blood pressure or lipid levels are at goal. This attitude, as shown by this review article, could have some negative effects on patient outcomes. What do you think? Should patients be discontinued on medications when they reach their goals? Or is this review finding specific to patients with both hypertension and diabetes?

 

Brunström M. & Carlberg, B. Effect of antihypertensive treatment at different blood pressure levels in patients with diabetes mellitus: Systematic review and meta-analyses. Bmj 2016;352:I717.